Interstitial emphysema of the head and neck

Abstract

A case of interstitial emphysema of the head and neck following dental surgery is described below; such cases might reasonably be attributed to trauma caused by the endotracheal tube used i n the anaesthetic technique. This was at first thought to be the cause in this particular case, but a review of the literature has revealed several other factors which may be implicated. Case reportThe patient was a fit man aged 27. He was admitted for removal of bilateral impacted lower wisdom teeth. He had had no previous illnesses or anaesthetics, and preoperative examination was normal.The patient was preniedicated with diazepam 10 mg orally in the early morning and papaveretum 10 mg and hyoscine 0.2 nig intramuscularly 1 hr pre-operatively.Anaesthesia was induced with thiopentone sodium 450 mg, followed by suxamethonium chloride 75 mg. A lubricated uncuffed, 8.5 mm Magill naso-tracheal tube was then passed through the right nostril and guided into the larynx under direct vision with the aid of Magill introducing forceps. A little resistance was met in the passage between the turbinates but the intubation was not considered to be traumatic.The endotracheal tube was connected to a Mapleson A circuit, and an attempt was made to institute artificial ventilation with oxygen, nitrous oxide, and halothane. Partial airway obstruction became immediately apparent. Laryngoscopy revealed that the tube was of inadequate length, as its bevel could be seen impacted in the anterior part of the larynx just above the cords. The tube was removed, hand ventilation via 21 face mask instituted and a further dose of suxamethonium chloride 50 mg was given prior to re-intubation using ii longer 8.0 mni tube. A throat pack was inserted and surgery was started.